药物超敏综合征24例临床分析

Clinical analysis of 24 patients with drug-induced hypersensitivity syndrome

目的探讨药物超敏综合征（DIHS）的临床特点及其诊治方法。方法回顾2013年11月至2015年2月复旦大学附属华山医院皮肤科病房收治的24例药物超敏综合征患者的临床资料。结果24例病例的可疑致敏药物分别为：别嘌呤醇（16例）、解热镇痛药（2例）、卡马西平（2例）、美西律（2例）、血栓通（1例）和柳氮磺胺吡啶（1例）。患者均以皮疹或发热为首发症状，于用药后3～10周发生，所有患者均出现肝功能异常，此外伴浅表淋巴结大者18例，肾功能损害者18例，白细胞升高者22例，血嗜酸性粒细胞显著升高者18例。结论临床治疗过程中一旦出现发热、全身皮疹伴浅表淋巴结大、血细胞异常以及嗜酸性粒细胞明显增高，且肝或肾功能受损等内脏损害病例要高度怀疑为DIHs，需立即停用可疑致敏药，早期足量使用糖皮质激素联合大剂量丙种球蛋白冲击治疗，有助于降低这一危重疾病的死亡率。

Objective To study the clinical features and laboratory findings of drug-induced hypersensitivity syndrome （DIHS）. Methods A retrospective analysis of the clinical features and laboratory results of 24 patients with DIHS who were hospitalized in Huashan hospital, Fudan university from November 2013 to February 2015 was made. Results The suspected drugs were as follows： allopurinol in 16 cases, anti-inflammatory analgesics in 2 cases, carbamazepine in 2 cases, mexiletine in 2 cases, Xueshuantong in 1 case and sulfasalazine in 1 case. The earliest manifestation of patients was skin rash or fever, which occurred within 3 to 10 weeks since the first administration of drugs. All the patients suffered from liver dysfunction, while we found multiple lymphadenopathy in 18 patients, renal impairment in 18 patients, leukocytosis in 22 patients and remarkable eosinophilia in 18 patients. Conclusion When a patient presented with extensive skin rashes, high fever, multiple lymphadenopathy, leukocytosis, eosinophilia and multiple organ impairment, especially liver and kidney, during the administration of specific drugs, one should take notice of the possibility of DIHS. Early and adequate use of corticosteroid combined with 1VIG treatment is recommended to decrease mortality rate of this lethal disease.